Many vets with PTSD prescribed opioid painkillers

NEW YORK (Reuters Health) - Veterans of the Iraq and Afghanistan wars who are treated for pain are more likely to get very strong painkillers if they also have mental health problems, including post-traumatic stress disorder, according to a new study.

That's worrisome, researchers said, because some people who take opioids -- which include OxyContin and Vicodin -- abuse the drugs or overdose on them, and those who already have mental troubles may be most at risk.

"There's really been a culture of, 'Let's get rid of pain,' and I think unfortunately that pendulum may have swung too far," said Dr. Karen Seal, from the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, the study's lead author.

"What we need to do now is really individually assess patients and talk to patients about what we know of the risks of opiates, especially in those with mental health problems," she told Reuters Health.

Prescriptions for the powerful painkillers have been on the rise not just among veterans, but in civilians as well, with more deaths and hospitalizations attributed to the drugs as a result.

According to the Centers for Disease Control and Prevention, the number of Americans who die of a prescription drug overdose has tripled in the past 20 years, with 14,800 people killed by an overdose in 2008 -- more than from heroin and cocaine combined.

Seal said that instead of taking opioids, some patients with pain and mental health problems may do just as well, or even better, with talk therapy, physical therapy and anti-inflammatory medications such as ibuprofen.

She and her colleagues analyzed data from about 141,000 war veterans who were treated for pain at a VA medical center between 2005 and 2010, some of whom also had been diagnosed with a mental health disorder. Out of all patients, close to 16,000 were prescribed at least a three-week course of opioids.

The researchers found that while less than seven percent of veterans without any mental health problems were prescribed the powerful painkillers, close to 12 percent with a diagnosis such as depression or anxiety were given opioids, and almost 18 percent with PTSD got a prescription.

More than one-third of veterans with both PTSD and a drug use disorder who had pain were prescribed opioids.

Veterans with PTSD were also more likely than others to be prescribed multiple opioid drugs at a time, to get higher doses of the drugs and to receive early refills, Seal and her colleagues reported Tuesday in the Journal of the American Medical Association.

And those treated with opioids were more than twice as likely as veterans not prescribed the painkillers to suffer an injury, overdose on drugs or alcohol or intentionally hurt themselves.

Seal said she thinks too many veterans are being prescribed opioids, instead of going to talk therapy and getting other types of pain treatment, for example.

"One of the things that we're trying to do is, if it appears that there may be a risk for unsafe use of opioids, to really bring that up honestly with the patients, and suggest that there may be other alternatives," she said. "It's important to be open to alternative ways of treating pain."

The study "further draws attention to the challenges of meeting the pain care needs of veterans with chronic pain and mental health conditions, particularly post-traumatic stress disorder," said Robert Kerns, the National Program Director for Pain Management at the Veterans Health Administration and a psychologist at Yale University in New Haven.

Kerns, who was not involved in the new study, agreed that it's important to develop other approaches for managing pain.

"At the same time I think it's still widely accepted that opioids may have a role in the management of chronic non-cancer pain, even in persons with mental health conditions," he told Reuters Health. But, "they need to be used responsibly and safely."

Seal said that veterans and their families should be open to the idea of talk therapy and other help for mental health problems.

"It's okay to accept mental health help," she said, "and that might actually help both their pain and their PTSD or other mental health problems."